Find out how instruments like forceps and ventouse can be used to help deliver your baby vaginally, and why you might have an assisted birth.
What is an assisted birth?
When instruments like forceps or ventouse are used during the second stage of a vaginal birth, it’s known as an assisted delivery. One-in-eight babies in England are born with the help of forceps or ventouse.
Having an assisted birth is no-one’s first choice, but being aware of why and how assisted births happen can help you feel more prepared and able to make informed decisions when you go into labour.
Forceps are a surgical instrument that looks like large tongs. They come in two halves; each half is carefully placed around your baby’s head while it is in the birth canal, and the two handles fit together.
The doctor pulls the forceps at the same time as you push to help deliver your baby.
Ventouse cap (vacuum)
A ventouse is a silicone cap attached to a suction pump. The cap is fitted on your baby’s head while it is in the birth canal, and it’s kept in place using suction.
The ventouse is then pulled by a doctor or midwife during contractions to help the baby be born, while you’re pushing at the same time.
Why might I have an assisted birth?
These are some of the reasons why you may be recommended to have an assisted delivery:
- You’re too exhausted: after a long labour, particularly a long second stage, you may not have the energy left to push the baby out all by yourself.
- Your baby’s in an awkward position: if your baby’s head is in an awkward position, it may not be able to descend into the birth canal without the use of forceps to turn it around.
- Concerns about your baby’s heart rate: if you’re dilated and your baby needs to be born quickly, having an assisted birth may be recommended over a c-section.
- For your health: in rare cases, you may have been told in advance that you shouldn’t push during the birth.
“I was pushing for two and a half hours and nothing much happened. I wasn’t worried for myself when I was told it would be best to have an episiotomy and deliver the baby with a ventouse cap – I just wanted them to get my baby out safely.” Read Victoria’s birth story
Forceps or ventouse – which is better?
Both forceps and the ventouse cap are used during the second stage of labour. The decision about which to use will depend on the circumstances of your birth and the clinical judgement of the midwives or doctors involved.
Generally speaking, a forceps birth is more likely to be successful in allowing the baby to be born without need for a c-section, but a ventouse is gentler and is less likely to lead to a severe tear for the woman in labour.
What happens during an assisted birth?
There are a few steps that you’re likely to go through during an assisted birth, though each birth is unique.
Your doctor or midwife should be able to explain everything to you during the birth and you should have the chance to ask questions before deciding how you wish to proceed.
- Checking your baby’s position: The midwife or doctor will see if your baby’s in a good position for an assisted birth through an internal examination and by feeling your bump. This will also determine which type of forceps or ventouse cap they will want to use.
- Giving consent: You’ll be asked to give consent for the instrumental delivery, either verbally or in writing. Your informed consent is always required for any procedure in birth.
- Preparations: You might be moved to an operating theatre for the assisted birth, or you may be able to stay in the delivery room you’re already in. You’ll be asked to lie on your back with your legs in stirrups.
- Anaesthetic: You’ll either be given a local anaesthetic, or a spinal or epidural anaesthetic. You may also need a cut at the vaginal opening (episiotomy) after the anaesthetics are working, to allow the instrument to be used and your baby to be born.
- The birth: The forceps or ventouse cap is put in place and you’re asked to push during contractions, while the midwife or doctor pulls the forceps or ventouse at the same time. Usually, more than one pull is needed for the baby to be born. However, there is a limit to how many pulls can be done safely. If your baby isn’t born with the use of instruments within a certain time, you may need to have a c-section instead.
“I had no idea that forceps delivery meant going through a caesarean-like procedure: I was brought to an operating theatre and had a spinal injection so I lost all sensation from the chest down. I also had a catheter for 24 hours after the birth.” Read Vikki’s story
Are there any risks with a forceps or ventouse delivery?
Like all birth intervention, an assisted birth comes with some potential complications for both you and your baby.
Possible complications for your baby
There are some risks of injury to the baby with forceps and ventouse cap, but they’re usually only temporary. You may notice:
- A mark on your baby’s head or face from the instrument: this usually disappears within a couple of days
- Small cuts on your baby’s face or head: these are very common but heal quickly.
- A bruise on your baby’s head: this also disappears in time, but it can cause an increase in jaundice in the early days. Talk to your midwife if you’re concerned.
“We had been warned that Molly’s head would be swollen and that she would have a lot of bruising from the ventouse cap, which was true. But when she was put on me after the birth, I didn’t even notice – you see through all that.”
Possible complications for you
With an assisted birth, you’re more likely to experience severe tearing and blood clots, as well as urinary and anal incontinence, compared to if you have a straightforward vaginal birth.
1% of women who have a unassisted birth suffer severe tearing, compared to 8-12% who have a forceps birth.
However, it can be worth bearing in mind that sometimes the only safe alternative to forceps or ventouse is an emergency caesarean section, which comes with risks of its own.
In other cases, the baby is already so far down the birth canal that it would be very difficult to even have a c-section at that point.
Can I avoid an assisted birth?
Birth is unpredictable and complications can occur in any situation. However, where and how you plan to give birth can affect your likelihood of needing interventions like forceps or ventouse.
Choosing where to give birth
Low risk, first-time mothers planning to give birth in a labour ward were almost twice as likely to have a forceps or ventouse delivery compared to those opting to have their baby at home or in a freestanding birth centre.
For women who’d had a baby in the past, the difference was even more pronounced: low-risk women who planned to give birth in the labour ward were more than four times more likely to have an assisted birth compared to those who were planning to have a home birth.
Use our Birth Choice tool to compare the intervention rates at your local units, side by side.
Preparing for birth
Beyond choosing where to have your baby, there are other things you can do to reduce the likelihood of an assisted birth, although not all of them are within your control.
Here are some of the things that have been shown to reduce the likelihood of having an assisted birth:
- Knowing the midwife who looks after you in labour
- Having good continuous support, preferably from both a midwife and a birth partner
- Being in upright positions or lying sideways when giving birth
- Avoiding having an epidural for pain relief if possible.
More from Which?
- Your birth plan: Give midwives, doctors and your birth partner a clear idea of what’s important to you during labour and birth.
- Pain relief in labour: From gas and air to epidurals – everything you need to know about your options in different birth settings.
- Why choosing where to give birth matters: How the choices you make can shape the care you’ll receive and your birth experience.
These are the sources of information used in this article.
Birthplace in England Collaborative Group, Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study, BMJ 2011;343:d7400 (2011)
Care Quality Commission, Maternity Services Survey 2018 (2018)
Health and Social Care Information Centre, Hospital Maternity Activity 2015-16, NHS
Royal College of Obstetricians & Gynaecologists, An assisted vaginal birth (ventouse or forceps), (2012)